Data collected in the early years of this project revealed that couples treatment of agoraphobia provided an advantage over agoraphobics treated without the involvement of their spouse at post-test. Now, 24-month follow-up suggests that this advantage is maintained and even increases on some measures. Preliminary results from process data, along with research from other Centers, suggests positive changes in communication surrounding agoraphobic issues is responsible for the most part for this continuing improvement although this is not now specifically targeted within our couples treatment. Despite these advances, very few patients recover from agoraphobia with any treatment, and most are left with moderate disability. Now investigators around the world have realized that panic attacks may be the primary problem within agoraphobia and yet our non-drug treatments for agoraphobia target primarily avoidance behavior. We have now developed, in the context of other research ongoing in our Center, a seemingly effective non-drug treatment for panic. In an attempt to devise a truly comprehensive and maximally effective non-drug treatment for agoraphobia, we propose to evaluate systematically the individual and combined advantage of adding two therapeutic modules to our standard couples treatment of agoraphobia. The first module will be a cognitive-behavioral treatment for panic. The second module will be communications training within the couple regarding phobic issues. These two modules will be evaluated in a 2 X 2 factorial design against the background of our standard couples treatment. Our purpose will be to move a step closer towards a comprehensive treatment for agoraphobia with panic (panic disorder with agoraphobia, DSM-IIIR) that addresses panic attacks, avoidance behavior, and the interpersonal or social system in which these symptoms occur. In addition, we will continue to follow all treated agoraphobics to examine long-term impact of treatment. We will also continue to investigate the implications of desynchrony among response systems in predicting long and short-term outcome, paying particular attention to new, potentially important predictors of outcome based on initial physiological responsivity in the phobic situation. Process analyses of marital relationship variables and phobic outcome will also continue as well as analyses of similarities and differences of male and female married agoraphobics on outcome and changes in marital adjustment.